Male Suicide in Rotherham

Jake Richards Excerpts

Monday 24th March 2025 Commons Chamber

[Jake Richards (Rother Valley) (Lab)]

In Rotherham, male suicide is a silent tragedy on the rise. As the local MP, I receive too many calls or messages early in the morning or late at night, telling me about another husband, father, brother or friend who has died in these tragic circumstances. Each call haunts us and our communities, but it is nothing compared to the unimaginable sense of grief and agony suffered by family and friends. The growing phenomenon of male suicide is part of a wider storm we face: of worsening mental health and mental health provisions for men; of splintering communities and support networks; and of a society that too often makes some men feel that they are unable to open up or reach out for help, or indeed that they are themselves part of the problem.

Tonight I want to make the argument for further Government action, and also offer a call to arms to us all. We can all do more to check in on our neighbours, friends and colleagues, and to build safe spaces for men to talk, to feel valued and to know that it is okay not to feel okay and that there is help. We should never forget the tragedy of women taking their own lives, too, and the particular circumstances that only women face that might lead them towards doing so. That matter is worthy of its own debate, though much of what we discuss will of course be relevant.

The numbers for men are startling and worth stating bluntly: suicide is the biggest killer of men aged under 50. Men account for three out of four suicides in England and Wales. A hundred men end their lives each week across the country. In Rotherham, men account for 79% of suicides.

[Lee Pitcher (Doncaster East and the Isle of Axholme) (Lab)]

In Doncaster last year, 80% of those who died from suicide were men, and we of course have one of the largest numbers of veterans in the whole of Yorkshire and the Humber. Doncaster council has the armed forces covenant. Will my hon. Friend join me in promoting its work, particularly around the veteran-friendly suicide prevention training that makes a huge difference to all the people who take part in it?

[Jake Richards]

My hon. Friend makes a good point. Just on Friday, I had the Defence Secretary, who is with us today, and the Veterans Minister in Dinnington to speak with veterans groups and organisations. Mental health provision was right at the top of the agenda, as it should be. Beyond each individual tragedy is a wider story. There is a specific challenge for policymakers in grappling with male suicide.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman, who I spoke to beforehand. This is his first Adjournment debate, and it is on a subject that every one of us understands only too well. I am saddened to hear the vast number of reasons contributing to male suicide in his constituency. There is certainly more to be done to support men across the UK. Suicide happens everywhere and especially in men—70% of the suicides in Northern Ireland are men. The majority of them occur in deprived areas. Does he agree that we need greater accessibility to mental health services in deprived areas to ensure that men are not left behind?

[Jake Richards]

I agree with the hon. Member, who makes a characteristically pithy point.

John Leaver, who does incredible work with men in tough times in Kiveton Park and Wales in my constituency, is in many ways the inspiration for the debate and the campaign I intend to run in Rotherham. John works with men and women, but has extensive experience of the particular issues that men face in his area. He has often been the person telling me of another suicide, and not infrequently it is somebody he knows well, played football with, went to school with or is an old family friend. He spoke to me about the effect of the decline of post-industrial towns and villages, such as Kiveton Park, Dinnington, Maltby and Thurcroft in my constituency, on men and notions of masculinity. Those places were built on the back of coalmining—a proud tradition of honest hard work, offering a sense of purpose and meaning for generations of young men. We should not simply look back with rose-tinted spectacles, but after the closure of the pits, we have too often struggled to replace that social fabric for men. These remain brilliant communities with a long-standing sense of solidarity and camaraderie, but too many within them still feel lost.

Even worse, too many men feel victimised or attacked. I was recently struck by the words of musician Sam Fender in a newspaper interview. Speaking about the towns in the north-east of England that he grew up in, he said lads were

“being shamed all the time and made to feel like they’re a problem. It’s this narrative being told to white boys from nowhere towns.”

I fear there is some truth to that—that men from towns built in a bygone era feel they are a problem in modern times. I want to play my part as the local MP in changing that, and I am not alone. Brilliant organisations in my constituency already do fantastic work. Andy’s Man Club in Maltby and Kiveton Park meet every Monday evening. Better Today, run by John Leaver, is incredible at supporting men in times of real difficulty. There are many fantastic sports clubs and associations, from boxing in Dinnington to Swallownest FC and Maltby Main FC. There are the regular coffee mornings, the walking and rambling clubs, and the monthly men’s breakfast in Anston. They all play a vital role in supporting men in difficult circumstances.

[Mark Sewards (Leeds South West and Morley) (Lab)]

Veterans have already been mentioned by my hon. Friend the Member for Doncaster East and the Isle of Axholme (Lee Pitcher). Would my hon. Friend join me in paying tribute to Veterans In Need Together? He talks about organisations that support men. That organisation supports men every Wednesday at Morley fire station without fail and offers support to those who need it.

[Jake Richards]

That service in my hon. Friend’s constituency sounds vital—just like those in my constituency. The focus on veterans in particular is critical.

Suicide does not simply affect the person taking their own life. Families lose loved ones and towns and villages are scarred by the traumatic loss of people with great promise and talent. The number of men who kill themselves every year is eclipsed by the number of people affected by their loss. I will use my role as the local MP to press the Government to take action. There are specific policy issues that I want to raise.

I am very aware of specific issues to do with gambling and male suicide. I have met two local mothers who are fighting for justice after their sons, both of whom were hard-working, talented and honourable men, took their own lives far too young as a result of spiralling online gambling addictions. Social media and technology have allowed vulnerable users easier access to gambling. A report found two years ago that there had been a 43% annual rise in demand for NHS gambling clinics, and that one in three of those patients had already attempted to take their own lives. It is estimated that every year there are more than 400 gambling-related suicides in England—and those are the ones we know of. I have before urged the Government to consider ways in which we can empower coroners courts, and indeed place responsibilities on coroners, to look at these issues in a robust and rigorous manner. At the moment, the causative link between gambling addiction and suicide is not given appropriate recognition.

There are broader issues. Although the issue of men’s mental health is complex, there are specific policy areas that the Government must confront. First, the rates of men taking their own lives are highest in the most deprived communities. The suicide rate in the most deprived 10% of areas in England in the two years from 2017 to 2019 was 14.1%—almost double the rate in the least deprived areas. Indeed, rates of men taking their own lives in the regions of England are almost double what they are in London. Tackling poverty and insecure work across our country is a Labour mission, and it is one that will save lives.

[Dr Danny Chambers (Winchester) (LD)]

I thank the hon. Member for giving way and for speaking so eloquently about this difficult and sensitive subject. On that point, it is known that those living in poverty are three times more likely to take their own lives or have mental health issues than people on the average wage. Linking into that, 85% of homeless people are men, and their homelessness is often related to mental health issues. I appreciate all the work that he is doing to highlight poverty.

[Jake Richards]

There is a direct link and we should not shy away from acknowledging, confronting and talking about it. When we talk about tackling poverty, we are talking about saving lives, too.

Secondly, we must save our NHS. This Government inherited a dilapidated health service and a particularly severely under-resourced mental health service. Fourteen years of under-investment and chaotic reform have hindered efforts to grasp this crisis. Long delays for treatment and diagnosis mean that so many men cannot get the support that they need and face worsening mental health in the meantime.

Thirdly, in my view we must be bolder in acknowledging the role that technology and social media have played in this crisis. New technology and social media can help efforts to combat men in difficult times: the internet can allow faster access to mental health provisions and can provide a network. However, it has been clear for more than a decade now that technology and social media can be deeply damaging to mental health, eroding confidence, often siloing rather than enhancing our communities, and exposing people to potentially harmful material. I know that many colleagues in the House have been moved by the Netflix drama “Adolescence”, which shines a light on the way the internet can remould ideas of masculinity and purpose—completely unbeknown to those closest to the 13-year-old boy in that drama.

Men, especially our young men, are spending less time outside and less time meeting people and communicating in person—all things that make us far happier and healthier. They are often sat alone for hours being bombarded with algorithms showing unrealistic representations of life, or communicating through anonymous group chats. Research shows that self-harm content has sometimes been allowed to flourish on social media by companies failing to remove explicit images and encouraging those engaging with such content to befriend one another. The arrival of smartphones has taken place in parallel with sharp rises in depression and anxiety in our young people. Of particular concern is the impact that mobile phones have on our young people. The average 12-year-old now spends 29 hours a week on their phone—equivalent to doing a part-time job.

[Liz Twist (Blaydon and Consett) (Lab)]

I commend my hon. Friend for securing the debate and for speaking so powerfully. Does he agree that we must also consider the employment-related, sectoral issues in tackling male suicide?

[Jake Richards]

Absolutely, and my hon. Friend has done so much admirable work in this area, long before my time in the House, so I can only learn from her. One point about suicide and male suicide is that an array of policy issues feed into it. This should not be a policy concern for the Government in silo; it should be part of every policy area, and every Department should have those concerns about mental health and suicide protection at its heart.

I was talking about mobile phones and the effect they have had. Since 2010, the average time that teens spend with friends each day has fallen by 65%. I applaud recent Government announcements about reviewing those policy areas, but I urge them to grasp the nettle when it comes to technology, phones, young people and mental health. In a decade’s time I believe we will wonder why we did not do so far sooner.

[Chris Coghlan (Dorking and Horley) (LD)]

I thank the hon. Member for securing this debate. I am working closely with him on the Mental Health Bill. Does he agree that one issue for families who are worried about their loved one is that when they are over the age of 18, there can be barriers in law in terms of the presumption of capacity and the Mental Capacity Act 2005 when it comes to raising the alarm with public authorities?

[Jake Richards]

I am grateful to the hon. Member, who has a remarkable ability to bring that important issue into any debate or intervention he makes. He is the most vociferous campaigner on that cause. I support him in that, and I know the Minister will also be listening.

I want to finish with the action I will take as the local MP. First, I pledge to continue to support the brilliant services we already have. I remember attending my first Andy’s Man Club in Maltby during the general election campaign. I must admit I was slightly cynical. I had seen the marketing, but questioned how effective or useful that informal meeting would be. I was blown away. Over the course of a few hours, a group of blokes spoke about their weeks, and their problems, over a cup of tea. Some of the chat was mundane: they were finding their work more boring, or they had had a good weekend with the family. Others were dealing with the most impossible trauma that put all else—in particular my election campaign—into stark perspective. Afterwards, everyone walked away ready to face the week, however big the challenges ahead. I have since met so many men who use that service. One of the first things I did once elected was to bring Andy’s Man Club to Parliament. I promise to continue to champion its work, and the work of many others.

I also regularly meet local health practitioners in Rotherham to hear their strategies to bring down the rate of men ending their own lives locally. The work of Rotherham health and wellbeing board, and the South Yorkshire integrated care system is hugely commendable, not least the emphasis on improving data and evidence to ensure effective and timely interventions, and providing tailored, targeted support to priority groups and effective bereavement support to those affected by men taking their own lives. Those plans sit within strategies to tackle loneliness, health inequality and domestic abuse. I have committed to holding regular meetings with all GP practices in my constituency, and other support groups, to help tackle male suicide.

We will hear from the Minister shortly about the Government’s national efforts, and from conversations with him I have no doubt that he grasps the severity of this crisis and the urgency with which this Government must confront it. Rest assured, I will be challenging the Government every step of the way to be ambitious in this agenda, and to ensure that policies will work for every town and village in Rotherham. Locally, I will be setting up my Rotherham taskforce to hold authorities to account, working with men and women who are on the front line confronting this issue. We will lead the ongoing awareness campaign and ensure that professionals, and local and national Government, treat this issue with the seriousness it deserves. I am grateful for the opportunity to speak about this important issue, and I hope that by doing so we begin more conversations across our borough. Together, we can bring about meaningful change, and save lives.

[Amanda Martin (Portsmouth North) (Lab)]

rose—

Terminally Ill Adults (End of Life) Bill (Twentieth sitting)

Jake Richards Excerpts

Committee stage
Tuesday 11th March 2025 Public Bill Committees

[Lewis Atkinson (Sunderland Central) (Lab)]

It is a pleasure to serve under your chairship, Sir Roger.

I rise to speak to a couple of the amendments. Amendment 348 is likely unnecessary. I would have been minded to support it had it referred to a registered GP, but the language of “usual or treating doctor” is unconvincing. I am not sure what those terms refer to. The registered GP absolutely should be informed, and both normal practice and the provisions in the Bill about entering information into medical records would mean that that is the case. For me, “usual doctor” is not the right terminology; it does not achieve what I think some of its proponents want. With reluctance, I will vote against that amendment because it does not refer to a registered general practitioner.

On amendments 303 and 458, I believe there must be provision for a second opinion. However, I am persuaded by the points made by the hon. Member for Richmond Park about amendment 459. I slightly disagree with my hon. Friend the Member for Stroud: although the independence of the second opinion is important on matters such as the terminal prognosis, when it comes to the detection of coercion, the more information, the better. It is one thing to be independent in a medical assessment, but the amendment speaks to a psychosocial assessment. We are trying to detect coercion, so it is important that every decision maker gets further information as the process progresses.

The provision for five different touchpoints of assessment is one of the strengths of the Bill. Each assessment should be done in a way that can be progressed with more information. It is not just five different independent points of information; because of the Bill’s record-keeping provisions, the assessment should become increasingly informed throughout the process. I certainly think that the panel, or whatever we get to, should have sight of any negative assessment from an independent doctor, as well as any positive one. The panel will then be able to do its job of scrutinising the two decisions, potentially weighing them up, and calling the different doctors who have given different decisions. I am, then, persuaded by amendment 459.

[Jake Richards (Rother Valley) (Lab)]

It came up in the debates last week that we heard some evidence from medical practitioners on how decisions and assessments were better made when done collaboratively. That means that we need to keep them independent but that, where possible, doctors should be working together in this process. Does my hon. Friend agree that amendment 459, tabled by the hon. Member for Richmond Park, may assist in that?

[Lewis Atkinson]

Yes, I do. I recognise the importance of independent assessment for prognosis and capacity. However, particularly with the issue of coercion, healthcare is a team sport, as anyone who has worked in healthcare knows. The more information and the more viewpoints we can get in those instances, the better. One of the strengths of the Bill is the team sense around it, which we will further in the amendments to clause 12 that we will come on to in due course.

I will finish briefly on amendment 460. I do not see the loophole that has been described. I think we would all want someone to be able to cancel their first declaration, and they are more likely to do so if they feel they have the option of going back and making a future first declaration. My worry with amendment 460 is that, by removing the word “particular”, it suggests that people are only able to make one first declaration in the course of their life. With the periods of reflection built into the Bill, which Members spoke about earlier, if someone changes their mind, they should cancel their first declaration. They are absolutely free to do so and the Bill, as currently drafted, makes good provision for that. To me, amendment 460 would remove the ability for that person to come back to that decision at a later point and go through the assessment process again. While I understand the motivations behind amendment 460, I am cautious about it for those reasons.

--- Later in debate ---

[Naz Shah]

Sorry, I will just finish my point.

From a common sense perspective—I am not medically qualified—that situation should make me, as a human being, want to understand more. As a human being, I would like to understand whether something else was going on, such as anger towards—

[Jake Richards]

Will my hon. Friend give way?

[Naz Shah]

Sorry, I will not give way until I have finished my point.

I would like those conversations to be at least explored, which is why I support the amendment.

--- Later in debate ---

[Jake Richards]

Does my hon. Friend agree that she is making a powerful case against amendment 468? A multitude of conversations and different circumstances will need to be taken into account; it is wholly inappropriate to have a mandated question in primary legislation. We should go back to clause 1, which I think the Bill is actually about. It states that the person must have

“a clear, settled and informed wish to end their own life”.

Does my hon. Friend agree that that is what is at the heart of the Bill, rather than decisions about what is in the person’s best interests?

[Naz Shah]

I respectfully disagree. I am making the case that there is a conversation to be had. Yes, there is informed choice but is my hon. Friend suggesting that the question should not be asked at all? I take the point that with an informed choice there would have been an exploratory conversation, but sometimes just calling something out, or stating the obvious, makes a huge difference.

Terminally Ill Adults (End of Life) Bill (Nineteeth sitting)

Jake Richards Excerpts

Committee stage
Wednesday 5th March 2025 Public Bill Committees

[Jake Richards (Rother Valley) (Lab)]

I was expecting someone else to have spoken in support of amendment 296, but I will be very brief. The tone of the debate so far has been respectful, and it should continue to be so. I hope that this will not be characterised as a personal attack on my hon. Friend the Member for York Central, who tabled the amendment, or anyone else who supports it, but this is a shocking amendment. It is shocking because I doubt that the motives behind it are to improve the Bill or make it safer. In fact, I fear that the motives are to build a political attack to support opposition to the Bill, rather than to be constructive in improving it.

I have come to that conclusion because there is no concept in any other piece of legislation, or in any healthcare guidance in operation, that would ever presuppose that a clinician would undertake a consultation, assessment or meeting that would ever put other patients in danger. I fear that this amendment has been tabled because some people are attempting to assert, perhaps not purposefully or wilfully, that the introduction of an assisted dying system would somehow force clinicians to put other patients at risk. If that is the assertion, that is wrong and—in my view—shocking. It is a shocking indictment on their view of our medical practitioners in the NHS.

[Danny Kruger]

The hon. Gentleman is impugning the motivation of his colleague, the hon. Member for York Central, who is herself an experienced practitioner in the NHS. To suggest that she has tabled this amendment improperly is a serious accusation, which I cannot believe that he really wants to make against his colleague. He said that the amendment’s intention is to suggest that assisted dying would cause problems in the NHS, but the explicit terms of the amendment are to ensure that that does not happen. Of course, no practitioner would want to take choices that would prejudice other patients’ care.

[The Chair]

Order. Mr Kruger, you are down to speak and you can make your point then. I want interventions to be short.

[Jake Richards]

I am grateful, Chair, and I can take further interventions on any further points from the hon. Gentleman, but I will deal with that one. This is not a personal criticism of my hon. Friend the Member for York Central. I do not doubt that she has good intentions. What I stated was that her opposition to the principle of the Bill is guiding some of the amendments that she has tabled, and this is one of them.

[The Chair]

Order. That is not a topic for this debate. Stick to the amendment.

[Jake Richards]

Not only do I question the motives behind amendment 296 but its necessity is—to put it politely—mind-boggling. We have attempted to navigate a balance between ensuring that, when clinicians are dealing with this process, they do so safely, and not mandating them to undertake such conversations, assessments and procedures in a straitjacket. Put simply, this amendment attempts to manage diaries. Primary legislation should not do that. We cannot use primary legislation to manage clinicians’ busy diaries, as this amendment attempts to do. It is not only unnecessary but challenges the integrity of our clinicians and what they do every day. Therefore, I will be voting against it, if it is pressed to a vote.

[The Chair]

I call Danny Kruger.

[Danny Kruger]

I was not intending to speak on this amendment, but since you have called me, Mrs Harris, I will quickly respond to the comments of the hon. Member for Rother Valley. I sincerely think that he should withdraw the suggestion that the amendment was made in bad faith and his remarks about the motivation of the hon. Member for York Central. She clearly tabled it only to make the Bill safer, which is the purpose of all the amendments, even if there might be very good reasons to disagree with them, so I regret that attack on her integrity.

On the point that we should simply rely on the integrity of clinicians—although the hon. Member for Rother Valley has not done so in respect of the hon. Member for York Central, who is herself a clinician—of course we do that. Nevertheless, the laws we make and the guidance we introduce send strong signals about priorities. The purpose of the amendment is to ensure that doctors do not feel that the obligations created by the Bill impose a duty on them to prioritise the assisted death procedure over other priorities. In fact, it would give clinicians genuine autonomy and freedom to make their own decisions—obviously, in consultation with colleagues and patients—about the appropriate prioritisation of the treatments and services they are offering.

The hon. Member for Rother Valley made the point that there is, in a sense, an attempt to suggest that the Bill should not become law because of the pressures it could impose on the NHS. I think that such pressures are a valid concern. When we create new laws, we should consider what new burdens they will place on existing services. We should consider whether the new service will be introduced and implemented safely, and its knock-on implications for the wider system.

[Jake Richards]

The point is that the amendment is not about the wider system; it is about a clinician’s individual decision making. Does the hon. Gentleman agree that that is a very different prospect?

[Danny Kruger]

Well, that concern for the individual clinician is in the context of their wider obligation to treat their patients well and to manage a resource—their own time—in a way that is equitable to all the patients they have to see. As often in these debates, we are really considering the extent to which we should be putting into the Bill an obligation on doctors to do the job that we hope that they are doing anyway. We do have such rules in the system to clarify what we expect of clinicians, however, and I think they would be appropriate in this case, given the resource requirements—which are unknowable, but with common sense one can see that they will be quite significant—that this new service would entail for many clinicians in the NHS.

[Jake Richards]

If the Government were to introduce legislation to expand the NHS’s role in how it undertakes operations in a certain area, would the hon. Member suggest that similar amendments should be added to that legislation, or it is just about this issue?

[Danny Kruger]

There is no rule that can be applied universally in the abstract. All rules take their value from how they are introduced. On the hon. Gentleman’s hypothesis, I do not in principle suggest that every new treatment and every new obligation that is created in the NHS should require laws determining how clinicians prioritise them. In the case of a new service—I am trying not to use the word “treatment”, because I do not accept it as such, but it sounds like it will be treated as an NHS treatment—that is very significant and whose resource implications are unknown, it strikes me as appropriate that, as far as possible, we should be clear that doctors should manage the resource demands placed on them by the Bill in the context of their other obligations to patients.

--- Later in debate ---

[Daniel Francis]

As my hon. Friend will know, my name is down as a supporter of amendment 6. I will get to that in due course. At the moment, I am speaking to amendment 284. I hear what my hon. Friend says—I am talking about the merits of amendment 284, but will get to amendment 6 in my closing comments.

On amendment 284, if a doctor has doubts about the capacity of an applicant, it is good practice to refer that person to a doctor with specialist expertise in that field. That would be true if the doctor was assessing the capacity of a patient to take any important decision, and is surely especially true when we are talking about a decision of this importance. I accept that people will have different views on amendment 6, when we get to it, from those they hold on amendment 284. Amendment 284 would put a duty on doctors to do something that is good practice. Most doctors in most circumstances would do it anyway, but in some cases, some may not. My hon. Friend the Member for York Central, who tabled this amendment, believes that we should write this law as tightly as possible so that doctors have that duty.

Amendment 294, which was tabled by my hon. Friend the Member for York Central, would require the doctor to base their assessment on provided evidence. Again, that is something that most doctors would do anyway in the extremely serious circumstances of a person’s applying for assisted death.

Many laws that we consider in this House relate to things that we are familiar with and understand well; but as my hon. Friend the Member for Bradford West said last week, some laws, such as this one, concern new matters. They are about things to which we need to give due consideration, as we are doing in scrutinising the Bill, because we need to understand the issues that arise. Those laws can introduce powers that could be dangerous if not properly safeguarded. This Bill, as has been accepted, needs strong safeguards. The aim of my hon. Friend the Member for York Central in tabling this amendment was to spell out that a doctor’s assessment of someone seeking assisted dying should be based on evidence. That would make it much less likely that any doctor would not pay sufficient attention to evidence they were presented with.

Lastly, as my hon. Friend the Member for Spen Valley knows, I am a long-standing of supporter amendment 6—I was in that base going into Second Reading. Alongside my concerns about clause 3, which she has heard at length, this matter was a key concern of mine going into Second Reading. I was therefore an early supporter of this amendment to change the wording around the referral from “may” to “must”. That was discussed on Second Reading. I do not want to speak for my hon. Friend, but I think she shares similar views to mine on the matter and suspect that the matter may be supported when we get to that debate.

[Jake Richards]

I will be brief. I will talk about my amendment 280, which I will not press to a vote. There remains an area that needs more exploring in this legislation—it has come up in debates already, but needs to be looked at further—namely, that a person may have capacity but have other mental health conditions that may impair their judgment. In those circumstances, a more thorough assessment than the two-doctor stage there is at the moment would be right. In reality, that is very likely to happen under the current structure of the Bill. My amendment simply attempts to make sure that it is mandatory. Having had discussions with my hon. Friend the Member for Spen Valley, I know that she is sympathetic to that.

There are amendments in the next group that aim to do the same thing. They, along with my amendment, may not be quite right. I urge the Government to look at this issue and see how we can work together to come to a conclusion, because I think that all members of the Committee would want that. I also support amendment 6, as I think everyone does.

[Dr Opher]

I apologise, Mrs Harris—I have got slightly confused with all the amendments. I do not have a speech that has been prepared for me, or anything like that, but I would like to make some comments. I think this is about the role of psychiatry and capacity, and how we deal that in the Bill. All these amendments reflect that. I would like to concentrate on whether we should actually mandate referral for all patients to a consultant psychiatrist, or adopt amendment 6, which suggests that if one of the two assessing doctors has concerns about either capacity or mental health, they should refer the patient to a psychiatrist. Those are the two choices I think we have here.

Terminally Ill Adults (End of Life) Bill (Sixteenth sitting)

Jake Richards Excerpts

Committee stage
Tuesday 4th March 2025 Public Bill Committees

[Dr Opher]

I absolutely agree. We are imagining that the doctors will all be independent and will not know anything about what other doctors have said, but there will be communication and access to medical records, and they will also tell the original doctor what their opinion is, and so on.

If we accept these amendments, we risk over-embroidering the Bill, which will make it almost impossible for doctors to say anything in a consultation. We must leave that free, because that is a central tenet of medical care, and if we put laws around it, there will be legal process over the medical consultation, and doctors will be frozen with fear about breaking the law. They are regulated by the GMC, and we are all terrified of referrals to the General Medical Council for that very reason: because we are trying to operate at the best standard that we can. I truly understand the amendments, but I do not think they will make the Bill any safer, and that is what we are all here for.

[Jake Richards (Rother Valley) (Lab)]

I am very sympathetic to the amendment and have thought long and hard about it. Can my hon. Friend explain to me, from his experience, but also from looking at the Bill and speaking to others, the effect of clause 4(4)(b)? As a non-clinician layperson, it appears to me that if a medical practitioner is discussing the likely effect of any treatment, then by its very nature that would lead to a discussion about prognosis, and the uncertainty and certainty around that.

[Dr Opher]

What my hon. Friend points out is absolutely true. The Bill’s drafting is simple but very effective. For prognosis, for example, it says that it is

“reasonably…expected within 6 months.”

As we have discussed many times in this Committee, prognosis is not exact; it is an estimate. It suggests that the patient has a terminal illness—that is to say, the illness will lead to their death. All we are arguing about is exactly when that will happen. It is reasonable to say, as doctors already do, “It is likely that you have six months to live.” That is not exact—as doctors, we cannot predict the future, even if people think we can. I totally accept that. However, we can make estimates as to what is likely to happen.

As my hon. Friend just mentioned, there are lots of really good news stories of people living longer than their prognosis. However, for the Bill to be effective, and to give relief to people who genuinely need it, we have to have a prognosis, based on medical evidence, of six months.

Terminally Ill Adults (End of Life) Bill (Thirteenth sitting)

Jake Richards Excerpts

Committee stage
Tuesday 25th February 2025 Public Bill Committees

[Naz Shah]

If we take that number, then that 30% or 40% who do not take that decision is maybe a few hundred people. However, the truth from Professor Sleeman’s evidence is that we are talking about thousands of people who are misdiagnosed every single year. She was talking about 3,516 who lived longer than expected. Yes, I recognise and value my hon. Friend’s comment that 30% or 40% of people do not take up assisted dying, but—perhaps I will talk about this when I move on to the next amendment—there is also a risk. If we go back to the Bill promoter’s intention to make the wording tighter, then surely this is a safeguard that she would support, just to ensure that we are making it as tight as we possibly can.

[Jake Richards (Rother Valley) (Lab)]

Can my hon. Friend clarify for me what she means by “reasonable certainty”, and how that differs from the clause as drafted? Can she also explain why, in her amendments, normal language around the burden of proof, such as “on the balance of probabilities” or “beyond reasonable doubt” is not used?

[Naz Shah]

First, this is not an issue for a tribunal, where it would be on the balance of probabilities; it is not an issue for a court of law or a criminal court, where we would be using proof beyond reasonable doubt. What I am trying to demonstrate is that doctors, in those diagnoses where they do get it right, have much more certainty. It might be that people have six months to live because they have different types of cancer. I am certainly not a clinician or an oncologist, but I know from the evidence we have had and from speaking to people that some people’s diseases—the specialists know better—have a trajectory of plateauing out and then dropping right at the end and some have a jagged kind of decline. Some of those diseases can be predicted with much more clarity than others. On the surface of it, in September, it might be the case for somebody that that is within the time—as for one lady who was told that she would not have more than six months to live. She is the founder of the Music of Black Origin awards and I was with her last week. She was absolutely fighting; she was not supposed to make it to that day. It is for the medics to decide—it is not for me to decide—but I would like medics to have much more certainty than they currently do, so that we would not have 47% of cases being misdiagnosed. That is what I am trying to get to, but I thank my hon. Friend for his intervention.

I argue that there is still a danger of using the standard prognosis that is currently in the Bill. The current research into doctors’ prognoses indicates that about half of their estimates are incorrect. My amendment would hold doctors to a higher standard of certainty. Under the measure, they would be explicitly held to a prognosis that death would occur with reasonable certainty within six months, and that that would have to be true even if the patient underwent all recommended treatment.

To go back to my hon. Friend’s intervention, this amendment is about raising the bar for how our medics make decisions. I submit that it would be a stronger test than the one currently included in the Bill. My hon. Friend the Member for Spen Valley has frequently stated that she wishes to create a Bill with the toughest safeguards in the world. I keep coming back to that, because the whole purpose of speaking to all these amendments is to put in opportunities to try to strengthen the Bill. By their nature, all these amendments reflect hon. Members’ concerns. This amendment would tighten the prognostic standard required of doctors and would therefore contribute towards tightening the Bill’s safeguards. I hope that hon. Members support it.

Finally, I turn to amendment 402. I will repeat a lot about anorexia, but it is an important amendment. I have tabled it for a simple but extremely important purpose: to prevent people from qualifying for assisted dying by stopping eating and drinking to the degree that they develop severe malnutrition, such that a doctor would give them a prognosis of six months to live. It specifically aims to protect people with severe eating disorders, including anorexia nervosa, and would also protect people with a severe wish, as one of the psychiatrists who testified before the Committee put it, to “hasten death”. I hope that my hon. Friend the Member for Spen Valley, and all other Committee members, will support this amendment.

Let us make no mistake: the Bill, as currently drafted, has a horrible loophole that all of us should seek to close. We know that anorexia sufferers and other people with eating disorders can and do stop eating to the point where they are dying of malnutrition. We should not allow such people to qualify for assisted death. Unfortunately, that is not a hypothetical danger; it is happening.

We know from the evidence that the Committee has received that that has happened in other countries. A group of eight experts on eating disorders submitted written evidence TIAB54 to the Committee some weeks ago. The experts included Chelsea Roff, who has been referred to many times in this Committee, and who gave clear testimony before the Committee, as well as seven medical doctors from hospitals in the UK, the US and Canada.

I hope that all Committee members have read the evidence, but I would understand if they had not, because we have had nearly 400 pieces of evidence to go through and very little time to read it. It seems to me, however, that if we are trying to write the best possible Bill, with the strongest possible safeguards, we have to pay the written evidence of experts the attention that it deserves. In their written evidence, that group of experts said:

“Patients with severe eating disorders frequently experience profound psychological distress and may express a desire to die. While this may appear to reflect a clear and informed wish, it is often a symptom of their psychiatric condition, which is remediable with appropriate treatment.”

The experts found that at least 60 patients with eating disorders received assisted death in several jurisdictions worldwide, including the US, Canada, the Netherlands and Belgium. I stress the phrase “at least 60” because we cannot be entirely sure that that is the full total. It is sadly the case that some jurisdictions are much more painstaking and transparent in the data they publish on assisted death than others.

In itself, it is tragic that people died in that way, but two things surely make the fact even worse. There are certainly men with eating disorders, but this is a problem that disproportionately affects women and girls. We know that the incidence of anorexia nervosa is much higher among women than among men in every age group. That is tragic. In every case we know of where a person with an eating disorder received an assisted death, that person has been a woman. I say it again: we cannot allow the Bill, as currently written, to stand. The Labour Government was elected with a mandate to reduce violence against women and girls. We surely cannot pursue that goal while at the same time increasing the vulnerability of women and girls who have eating disorders. There is nothing in the Bill as it currently stands that would stop doctors signing off on assisted death for someone who had starved themselves into malnutrition.

The courts in England and Wales have already begun accepting that some people with anorexia have reached a terminal stage. In the Court of Protection case, The NHS Trust v. L & Others, which took place in 2012, a 29-year-old with severe anorexia was described in the ruling as follows:

“The prospects of her recovery overall approach zero…given that it is extremely unlikely that Ms L will recover from her anorexia…in best interests to move to palliative care if L…in terminal stage of her illness.”

The right hon. Member for North West Hampshire raised the Court of Protection. There are 10 cases where the Court of Protection has made rulings. Of them, only one case, in 2012, ruled that the young lady could be force-fed.

Terminally Ill Adults (End of Life) Bill (Fourth sitting)

Jake Richards Excerpts

Committee stage
Wednesday 29th January 2025 Public Bill Committees

[The Chair]

Jake Richards was not called for the last panel, so we will start with him.

[Jake Richards (Rother Valley) (Lab)]

Q Thank you for those introductory statements. I have a question for Mr Amin regarding the current operation of the Mental Capacity Act 2005, and how the Court of Protection approaches that issue. The Bill as currently drafted essentially defers to the Act, and I wondered if you have any reservations about that, or any thoughts that you could offer the Committee?

Yogi Amin: Reservations—no. In fact, I wholly recommend and support the idea as drafted to defer to the Mental Capacity Act for capacity assessments. I have been working in this area for over 20 years, before and after the Mental Capacity Act came in, and I have done cases all the way up to the Supreme Court, as well as day-to-day different cases around the country. It is well understood how capacity assessments are done, and it is ingrained into the practice of practitioners generally and of legal practitioners in the courts. Certainly when I give training to advocates, doctors and so on, it is well understood how to apply the test. That could be adapted for this particular decision, which is done here. In the past couple of years, we had a decision in the Supreme Court which settled how to approach the question of capacity, and to disturb that would concern me.

[Jake Richards]

Q To be clear, would it concern you because it would cause confusion?

Yogi Amin: It is a well settled and understood approach to the law, and producing a new one would throw up a whole new conundrum, where people would be questioning how to approach it, etc. It is not broken—it works well.

[The Chair]

That was a specific question to Mr Amin, but it is an important issue. Does anyone else wish to come in, briefly please?

Chelsea Roff: One thing I would like to highlight in our study is that all 60 people who died—young women, mostly—were found to have mental capacity to make the decision to end their life, so I worry that mental capacity will not be an effective safeguard to prevent people with eating disorders from qualifying under the Bill.

I also note that Oregon and California, where I am from and where we have found cases, have an additional safeguard to mental capacity. That is, if there are any indications that the person might have a mental disorder, that person must be referred for a mental health assessment. It is important not to make a false equivalence between mental capacity and mental health.

We could, for instance, have a person who has a prognosis of six months or less, but their wish to die is emerging from severe depression, from suicidality. We saw very high rates of suicidality and depression: 89% were depressed and nearly half chronically suicidal when they died. Physicians emphasised, still, that the wish to die was not emerging from a mental illness, despite them having diagnosed mental illness.